Notice2025-23131
60-Day Notice of Proposed Information Collection: Medical History and Examination
Primary source
Metadata and text below are from the Federal Register, a public-domain U.S. government work. Always verify the official published version before relying on it for any legal matter.
Published
December 17, 2025
Issuing agencies
State Department
Abstract
The Department of State is seeking Office of Management and Budget (OMB) approval for the information collection described below. In accordance with the Paperwork Reduction Act of 1995, we are requesting comments on this collection from all interested individuals and organizations. The purpose of this notice is to allow 60 days for public comment preceding submission of the collection to OMB.
Full Text
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<title>Federal Register, Volume 90 Issue 240 (Wednesday, December 17, 2025)</title>
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[Federal Register Volume 90, Number 240 (Wednesday, December 17, 2025)]
[Notices]
[Page 58725]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2025-23131]
[[Page 58725]]
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DEPARTMENT OF STATE
[Public Notice 12878]
60-Day Notice of Proposed Information Collection: Medical History
and Examination
ACTION: Notice of request for public comment.
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SUMMARY: The Department of State is seeking Office of Management and
Budget (OMB) approval for the information collection described below.
In accordance with the Paperwork Reduction Act of 1995, we are
requesting comments on this collection from all interested individuals
and organizations. The purpose of this notice is to allow 60 days for
public comment preceding submission of the collection to OMB.
DATES: The Department will accept comments from the public up to
February 17, 2026.
ADDRESSES:
You may submit comments by any of the following methods:
<bullet> Web: Persons with access to the internet may comment on
this notice by going to <a href="http://www.Regulations.gov">www.Regulations.gov</a>. You can search for the
document by entering ``Docket Number: DOS-2025-0434'' in the Search
field. Then click the ``Comment Now'' button and complete the comment
form.
<bullet> Email: <a href="/cdn-cgi/l/email-protection#165b7764627f78736c5c572156656277627338717960"><span class="__cf_email__" data-cfemail="e5a88497918c8b809fafa4d2a59691849180cb828a93">[email protected]</span></a>.
<bullet> Regular Mail: Send written comments to: Medical Director,
Office of Medical Clearances, Bureau of Medical Services, 2401 E Street
NW, SA-1, Room L-101, Washington, DC 20522-0101
<bullet> Fax: 202-647-0292, Attention: Medical Clearance Director
You must include the DS form number (if applicable), information
collection title, and the OMB control number in any correspondence.
FOR FURTHER INFORMATION CONTACT: Direct requests for additional
information regarding the collection listed in this notice, including
requests for copies of the proposed collection instrument and
supporting documents, to Jessica Martinez, Director of Medical
Clearances, who may be reached on (202) 663-1657 or at
<a href="/cdn-cgi/l/email-protection#723f1300061b1c17083833453201061306175c151d04"><span class="__cf_email__" data-cfemail="8dc0ecfff9e4e3e8f7c7ccbacdfef9ecf9e8a3eae2fb">[email protected]</span></a>.
SUPPLEMENTARY INFORMATION:
<bullet> Title of Information Collection: Medical and History
Examination.
<bullet> OMB Control Number: 1405-0068.
<bullet> Type of Request: Revision of a Currently Approved
Collection.
<bullet> Originating Office: Bureau of Medical Services, Office of
Medical Clearances (MED/CP/CS/CL).
<bullet> Form Number: DS-1843 and DS-1622.
<bullet> Respondents: Chief of Mission personnel and eligible
family members.
<bullet> Estimated Number of Respondents: 2,039.
<bullet> Estimated Number of Responses: 2,039.
<bullet> Average Time Per Response: 1 hour.
<bullet> Total Estimated Burden Time: 2,030 hours.
<bullet> Frequency: Upon application/employment for an overseas
position and then intermittent, as needed.
<bullet> Obligation to Respond: Required to Obtain or Retain a
Benefit.
We are soliciting public comments to permit the Department to:
<bullet> Evaluate whether the proposed information collection is
necessary for the proper functions of the Department.
<bullet> Evaluate the accuracy of our estimate of the time and cost
burden for this proposed collection, including the validity of the
methodology and assumptions used.
<bullet> Enhance the quality, utility, and clarity of the
information to be collected.
<bullet> Minimize the reporting burden on those who are to respond,
including the use of automated collection techniques or other forms of
information technology.
Please note that comments submitted in response to this Notice are
public record. Before including any detailed personal information, you
should be aware that your comments as submitted, including your
personal information, will be available for public review.
Abstract of Proposed Collection
Forms DS-1843 and DS-1622 collect medical history, screenings and
physical examinations for all individuals applying for overseas
positions, including their eligible family members. Forms DS-1843 and
DS-1622 are designed to collect sufficient and current medical
information on the individual for a medical provider to make a medical
clearance determination for initial appointment to an overseas
assignment. They are also used to determine whether the individual or
eligible family member will have appropriate medical and/or educational
resources at a diplomatic mission/host country abroad to maintain the
health and safety of the individual or family member. The forms were
updated to include questions regarding employment agency information
for non-foreign service agencies.
Methodology
The respondent will initially answer the questions on pages 1-3 of
the forms digitally. They will then be prompted to download the auto
populated form with their responses and take it to their personal
medical provider for completion and authorization of pages 4-5. Once
complete, the forms will be submitted via a secure online platform for
review by the Office of Medical Clearances.
Jessica A. Martinez,
Director of Medical Clearances, Bureau of Medical Services, Department
of State.
[FR Doc. 2025-23131 Filed 12-16-25; 8:45 am]
BILLING CODE P
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This is legal information, not legal advice. Laws vary by jurisdiction and change frequently. Always verify current law with official sources and consult a licensed attorney in your jurisdiction for advice on your specific situation.